As the name suggests, these lines are produced from our expressions. They result from years of any facial movements such as smiling, laughing and frowning, as well as the sub-conscious tension in our facial muscles when we react to stress. When our muscles contract, they create folds, and so lines on the skin above them. These constant, daily muscle movements will only make the lines deepen over time, and the longer the muscles remain tensed, the deeper the expression lines become.

If there is additional photo-damage with loss of collagen and elastin in the dermis, the skin is lax and the expression lines will be more obvious during the expressions.

The most common expression lines are:

1. Crow’s feet, or laugh lines, at the outsides of the eyes corner. These are produced by the underlying circular eye muscles called orbicularis oculi.

2. Forehead horizontal lines. These are produced by the upward movement of the forehead muscle called frontalis. This happens when one is frowning due to stress or trying to appear alert with raised eyebrows and upper eyelids.
3. Glabellar frown lines. These happen when one is frowning with disapproval or puzzle, pulling the eyebrows together to the middle. The lines appear as 2 or 3 vertical lines in between the eyebrows, sometimes so deep that they look like a knife cut.
4. Fine vertical lines radiating out from the lips. These are due habits involving frequent pursing of the lips such as smoking.

An example of how forehead lines are reduced by Botox:

There are quite a few ways to improve these expression lines. There are the injectables such as Fillers or Botox. Fillers work by simply filling in the space but they are more ideal for resting, rather than dynamic lines here. Botox hits the problems right there by semi-paralysing the muscles, thereby not allowing as much expressions as before. With time the muscles also learn to relax more with less frequent injections. Some may just not like the idea but so far Botox is extremely popular for this purpose. One may worry about the lack of facial expression but this is usually mild and does not interfere with social interactions.

Surgical face-lift will help too but even this most extreme remedy is only good for around 5 to 7 years before wrinkles and deep expression lines reappear. It also carries the same risks as any major surgery. Nowadays, it is mostly replaced with Laser Facial Tightening, of which the most promising and thrilling one is Fractional CO2 Laser.

We shall have more details on Fillers, Botox, and different laser treatments under the section of Aesthetic Treatments.

Crow’s Feet or smile lines are those lines on the sides of the eyes. They are caused by the contraction of the circular muscle surrounding the eyes. Sunken temples and sagging upper eyelids will also make the crow’s feet deeper in appearance.

The most direct way of treating crow’s feet is to inject Botulinum over the area. The Botulinum directly reduces the contraction strength of the muscles and therefore the muscles cannot create the creases as usual. The effect usually comes on in 3 to 5 days and will last for about 5 to 6 months. However, with repeated injections over time, the muscles will learn to relax more and the frequency of injections can become less and less often gradually.

Points of Injections

Some people worry that the Botulinum will make them look frozen. Normally this should not happen, and if it does even slightly, it is due to improper technique of the injector or too much dosage is being injected. Experience is important here.

Also, it helps to inject a small amount of Hyaluronic Acid Dermal Filler to make the skin fuller and more resistant to have creases when smiling.

Surgical face lift also helps to improve expression lines but this is the ultimate option, and it probably holds for only 5 to 7 years, after that the lines will reappear. It is also important to take into account the large surgical risks associated with it. It is now largely replaced by other treatment modalities and with appropriate preventive treatments, this can be totally avoided. For examples:

• Sculptra
• Thread Lift

Other high energy devices treatments, including:

• Laser Skin Tightening
• Fractional CO2 Laser
• Radio-Frequency
• High Intensity Focused Ultrasound

These horizontal lines are caused by the upward contraction of the forehead muscles, when someone is expressing a tense surprised emotion, or raising the eyebrows and upper eyelids during an alert state.

The most direct way of treating crow’s feet is to inject Botulinum over the area.The Botulinum directly reduces the contraction strength of the muscles and therefore the muscles cannot create the creases as usual. The effect usually comes on in 3 to 5 days and will last for about 5 to 6 months. However, with repeated injections over time, the muscles will learn to relax more and the frequency of injections can become less and less often gradually.

One week after injection

Some people worry that the Botulinum will make them look frozen. Normally this should not happen, and if it does even slightly, it is due to improper technique of the injector or too much dosage is being injected. Experience is important here. There is a chance of mild drooping of the upper eyelids for some older persons or if there is already pre-existing eyelids drooping.

Alternatively we can also consider:

• Hyaluronic Acid Dermal Filler
• Sculptra
• Thread Lift

These lines happen when one is expressing an emotion of disapproval or feeling puzzled, and draws the eyebrows towards the middle. There are 2 to 3 vertical lines and sometimes they can be so deep that they look like scars from cutting injuries.

The most direct way of treating crow’s feet is to inject Botulinum over the area.The Botulinum directly reduces the contraction strength of the muscles and therefore the muscles cannot create the creases as usual. The effect usually comes on in 3 to 5 days and will last for about 5 to 6 months. However, with repeated injections over time, the muscles will learn to relax more and the frequency of injections can become less and less often gradually.

Some people worry that the Botulinum will make them look frozen. Normally this should not happen, and if it does even slightly, it is due to improper technique of the injector or too much dosage is being injected. Experience is important here.

As said, the lines can be very deep, in that case it may necessary to add in extra Hyaluronic Acid Dermal Filler to smooth them out.

Just a note to mention that those vertical lines surrounding the mouth are frequently caused by movement to tight up the lips, such as smoking, while the naso-labial folds will deepen on smiling. These two types of lines cannot use Botulinum to rectify.